Melanoma Update
I finally had the wide excision on Tuesday. It was actually supposed to be Monday, but the first surgeon I saw wasn't comfortable doing anything due to the location on my toe, and my medical history. He referred me to his colleague, who is "the melanoma guy." This actually worked out really well, as my mom (who came down to be with me for my appointment) used to work quite closely with this surgeon (she's a nurse). She was very happy that he'd be doing the procedure and was confident in his skills and expertise. Due to the connection, the nurses definitely pulled some strings to make sure I could get in to see him asap. They were all really great in taking my concerns about having already been off of Humira for a month seriously, and understood why we needed to get the excision done right away so I can restart my therapy. The surgeon's office got me in to see him the next morning, and he asked me what I'd prefer for procedure. I went in being pretty against the idea of a skin graft if it was going to be needed, given my history of infections and shit just going wrong. He weighed an excision vs an amputation, but told me he thought amputation right off the bat would be a little aggressive. He was confident he'd be able to close the wound without grafting, but told me it would be extremely tight, and the margins would be very close. I agreed to do the excision as recommended, but if my margins aren't good enough when pathology comes back, he'll amputate the whole toe. The excision itself was fine. The doctor made a remark about Crohn's patients not always having a great pain tolerance (?), and was then impressed when I didn't flinch for the injection in the bottom of my foot. He loaded me up with short- and long-acting freezing too, which was great. The excision went down to the bone, and he also said that he hit part of my nail growth plate, so I might have some issues with that toenail going forward, no biggie. He put three huge retention sutures in, and two smaller ones. I go back in three weeks to get them out. In the meantime, he asked for the pathology to be rushed for me. It usually takes about three weeks, which would mean missing at least two more doses of Humira. We'll see if the request will actually result knowing what's happening faster. For now, we know that it's definitely Stage I, and likely a Stage Ib. The thickness was only 0.43mm, but the mitotic rate of 1 was more of a concern. The surgeon should know definitively when I go back to see him for future removal. If he gets the pathology before that, and I do need the amputation, I assume that would happen before. There wouldn't be much point in taking them out if the toe is just coming off. He prescribed me Percocet for pain, and said it would be pretty sore once the local wore off. He was right. The pain level resulted in me taking two Percocet every 5 hours, until the vomiting started. I took the last two at 4:30am when the pain woke me up, and then I pretty much barfed from 7:30, when I got up, until 4:30pm. I actually tried to go to work, and ended up under my desk, puking into my wastepaper basket. I went home and barfed some more, called the doctor, who switched me to tramadol, and went to sleep. So, no more Percocet for me. Ever. 🤢 All in all, I don't feel too bad about it, but I need to book with the dermatologist to make sure nothing else looks suspicious before we can think about going back to trying to conceive. The surgeon did reassure me, though, by saying that I can absolutely get pregnant as soon as it looks like we have everything under control. There's no need to wait for a certain number of months/years to watch for recurrences. So far not having any bleeding, but definitely seeing the results of the stress on my gut. Fingers crossed I make it long enough to get back on Humira without losing my remission. This whole skin cancer thing is super crap.
